Eyelid conditions often need urgent attention, so having immediate access to support from pharmacy can be particularly helpful for patients, reports Kathy Oxtoby…

Eyecare is a key category for pharmacists who can give patients information, advice, and support, without waiting to see their GP. Having that immediate access is particularly important with eye problems as “this is a very sensitive part of the body, and eye conditions can be quite uncomfortable,” says Lila Thakerar, superintendent pharmacist at Shaftesbury Pharmacy in Harrow.

She says it’s important for pharmacists to keep up to speed with eyelid conditions, including their diagnosis, what treatments are available, and when to refer.

Stye

A small painful lump inside or around the eyelid could be caused by a stye. The skin around the stye may be swollen and red, and the stye may be filled with yellow pus. The eye may be red and watery, but vision should not be affected. A stye usually only affects one eye, but it's possible to have more than one at a time ¹. 

Styes are often caused by bacteria infecting an eyelash follicle or eyelid gland, and can be avoided by keeping the eyes clean ¹.  Styes are common and should clear up on their own within one or two weeks ¹.

To reduce swelling and help the stye heal, patients can “soak a clean flannel in warm water  and hold it against the eye for five to ten minutes, repeating this three or four times a day”, advises Ms Thakerar. Pharmacists can also provide OTC eye ointments, she says.

To relieve pain, patients can take painkillers such as paracetamol or ibuprofen, says Iftikhar Gulfraz, superintendent pharmacist at Eye Pharmacy, with branches in Mirfield and Ravensthorpe that each has an optician service on-site. 

Patients are advised to avoid wearing contact lenses and eye make-up until the stye has burst and healed ¹.  Patients should be referred to their GP if the swelling becomes worse, if the stye does not get better within a few weeks, or if it is affecting their vision ¹.

Chalazion

If the lump is hard but not very painful it’s likely to be a chalazion -  a common condition in which a small lump or cyst develops in the eyelid due to a blocked oil gland ². 

“The chalazion will often vary in size over a few weeks and can discharge spontaneously or disappear after hot compresses and lid cleaning,” advises Moorfields Eye Hospital NHS Foundation Trust ².   

To prevent chalazions a a warm moist flannel, should be used to clean the edge of the  eyelids twice daily ². If the eye becomes increasingly red or painful after treatment or sight becomes more blurred the patient should be referred to a doctor.

Allergies

With allergic reactions, OTC medications can usually help relieve symptoms, but people with severe allergies may require additional treatment ³. 

If the allergy symptoms are due to hay fever then treatment can include non-drowsy antihistamines, says Mr Gulfraz.

Blepharitis

Blepharitis, which causes swollen, itchy eyelids, is not usually serious and can often be treated by washing the eyelids every day ⁴. Pharmacists can suggest eye ointments or eye drops to treat infection, says Ms Thakerar.

Symptoms include sore eyelids, itchy eyes, a gritty feeling in the eyes, flakes, or crusts around the roots of the eyelashes, and eyelids sticking together in the morning on waking up ⁴.

It can be caused by bacteria, seborrhoeic dermatitis, or the glands inside the eyelids not producing enough oil, and cannot be spread to other people ⁴.

If the condition doesn’t improve, or the patient’s vision is affected they should be referred to their doctor, says Mr Gulfraz.

Conjunctivitis

Conjunctivitis is an eye condition caused by infection or allergies. Typically, it affects both eyes making them red, burn or feel gritty, produce pus that sticks to lashes, itch, and water. It usually gets better in a couple of weeks without treatment. Conjunctivitis that produces sticky pus is contagious ⁵.

Mr Gulfraz says the infected area should be cleaned with warm water, and hands should be washed regularly to avoid cross infection. Conjunctivitis can be treated with antibiotic eye drops, but if there is no improvement within a few days patients should be referred to their GP, he says.

Xanthelasma

Bumpy yellow patches on the inside corners of the eyelids or around the eyes could be signs of xanthelasma ⁶. The condition is not harmful, but in rare cases may be an indicator of possible heart disease, so should be checked by a doctor ⁶.

Patients may wish to have the patches removed, which will need a referral to a doctor, advises Ms Thakerar.

Ectropion and entropion

Ectropion is where the lower eyelid droops away from the eye and turns outwards, and while not usually serious,  can be uncomfortable ⁷.

Ectropion can happen in one or both eyes. The drooping eyelid can disrupt the drainage of tears, which can make the eyes sore, red, and irritated, water excessively, feel dry and gritty, and be more vulnerable to infections like conjunctivitis ⁷. 

Ectropion can happen as the tissues and muscles of the eyelids become weaker with age ⁷. Patients can use eyedrops during the day and eye ointment at night to reduce irritation and keep the eye lubricated ⁷.  

If ectropion is severe and not treated, it's possible to develop a corneal ulcer that could affect vision ⁷. Severe ectropion may require an operation to correct the problem ⁷.

Entropion is a condition in which the edge of the eyelid - usually the lower lid - rolls inwards, so that the eyelashes touch the surface of the eye, and is commonly caused by ageing ⁸.

The affected eye becomes irritable, red, and watery, and vision may be blurred. Patients may be helped by artificial tears and unmedicated ointments. These measures will not cure the condition, so patients are often referred to an ophthalmologist for consideration of surgery. ⁸

Cellulitis

Cellulitis is usually caused by a bacterial skin infection, and can occur in any part of the body. Cellulitis in the eye is very serious ⁹. The eyelid can become hot, painful, and swollen and the white part of the eye may become red ⁹.

“Cellulitis should be treated as a medical emergency, and the patient should be referred straight away,” says Mr Gulfraz.

Early treatment with antibiotics can stop cellulitis becoming more serious. Patients should contact their doctor if the condition does not improve after two or three days of taking antibiotics ⁹.   

If cellulitis is not treated quickly, the infection can spread to other parts of the body, such as the blood, muscles, and bones ⁹.

“With some eyelid conditions we can assist with soothing preparations such as eyedrops and ointments,” says Ms Thakerar. “But with other conditions, such as cellulitis, we shouldn’t waste any time with regards to referring patients.”

Sometimes a prompt referral from pharmacy can even save a patient’s sight.  Mr Gulfraz says he has had patients come to the pharmacy to thank him, saying their vision would have been impaired had he not referred them straight away. This highlights “just how valuable pharmacy can be.”

References

1. NHS (2021) Stye. https://www.nhs.uk/conditions/stye/
2. Moorfields Eye Hospital NHS Foundation Trust (2021) Chalazion. https://www.moorfields.nhs.uk/condition/chalazion-0
3. Kerr M, Cherney K (2020) Eye Allergies. Healthline. https://www.healthline.com/health/allergies/eye-allergies
4. NHS (2022) Blepharitis. https://www.nhs.uk/conditions/blepharitis/
5. NHS (2021) Conjunctivitis. https://www.nhs.uk/conditions/conjunctivitis/
6. Fitzgerald N (2017) What Is Xanthelasma? Healthline. https://www.healthline.com/health/xanthelasma
7. NHS (2021) Ectropion. https://www.nhs.uk/conditions/ectropion/]
8. College of Optometrists (2022) Entropion. https://www.college-optometrists.org/clinical-guidance/clinical-management-guidelines/entropion#:~:text=Entropion%20is%20a%20condition%20in,part%20of%20the%20ageing%20process.
9. NHS (2021) Cellulitis. https://www.nhs.uk/conditions/cellulitis/